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Pharmacy Benefit Managers (PBMs) CVS, Express Scripts, and OptumRX have once again sidestepped additional reforms in spending bills as part of last month’s government budget deal. Following the week-long recess, it's unlikely that any significant measures will be taken this year, with attention shifting to the upcoming fall elections. This stalemate occurs amid bipartisan criticism of these industry intermediaries, who are pivotal in influencing prescription drug prices.
PBMs are companies that manage prescription drug benefits for insurance companies, large employers, and Medicare. They negotiate fees and discounts with pharmaceutical companies and determine which drugs are available and their costs to individuals. They also collect fees from payers and rebates from drugmakers based on sales volumes. Conflicting studies provide mixed views: some suggest that rebates help lower costs for the government and consumers, while others indicate that drug prices increase disproportionately to the rise in rebates.
CVS Caremark, Express Scripts, and OptumRX control 79% of the market. Over the past year, lawmakers have introduced twelve bills—five with bipartisan support—aimed at making PBM negotiations more transparent and potentially subjecting rebates to further governmental review. Given the bipartisan nature of these concerns, it is likely that legislative action will follow the election, regardless of the outcome. Both former President Donald Trump and current President Joe Biden have expressed a commitment to reducing prices on commonly used medications.
As this issue continues to evolve, you can stay informed by using Cloverleaf AI. Over the past 90 days, there have been more than 344 meetings focusing on PBMs and an astonishing 1,713 mentions of these entities.
Interested in tracking every government meeting where PBMs are discussed? Get a demo with Cloverleaf AI.
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